Westwood Hall Nursing Home

We found the following examples of good practice.

People living in the home and their relatives were supported to maintain contact. There was visiting pod outside the front entrance so relatives could see their loved ones regularly reducing the risk of infection to visitors and people living at the home.

The registered manager was aware of their responsibilities and managed the COVID-19 outbreak with support from relevant partner agencies.

There was a programme of regular COVID-19 testing for both people living in the home, staff, essential carers and visitors to the home. Screening procedures included temperature checks, healthcare questionnaires and a negative lateral flow test.

Staff used personal protective equipment (PPE) and followed guidance and practices. There was abundant PPE available to staff.

The inspection was unannounced and took place on the 12 and 14 November 2018. At the last inspection carried out in June 2016, we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of Medication Administration Records (MAR) not being completed at all times and the safe storage of medication. Temperature records for the medication rooms and medication fridge temperatures were not taken to ensure medication was stored at a safe temperature for the people living at the home. Actions had been implemented and audits completed to ensure the medication procedure was completed effectively by staff.

Westwood Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate up to 52 people, there were 42 people living at the home at the time of our inspection. Westwood Hall Nursing Home is situated in Brimstage, Wirral and has large gardens surrounding the home. The building has two floors with two lifts to access the first floor.

The service is run by a manager who is registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and knew how to report their concerns to the local authority.

People were supported to take their medication as prescribed. Medication audits were carried out on a monthly basis to help identify and address any issues. Medication records were being signed appropriately by staff and controlled drugs were being stored securely as required by law.

Staff had received the training they needed to carry out their role effectively. New staff were supported to gain the necessary skills and qualifications and shadowed experienced staff to gain knowledge of the role. Staff spoken with and records seen confirmed training had been provided to enable them to care and support people with their specific needs. We found staff were knowledgeable about the care and support needs of people in their care. We saw that individuality was encouraged and supported and people were able to express themselves in the way that they chose and that their well-being was enhanced by this support.

Everyone we spoke with, spoke positively about the registered manager and the staff. We observed positive interactions between people and staff.

There was a complaints procedure at the home and we were told by people and relatives that they were aware of how to make a complaint and all would talk to the manager. There was information on how to make a complaint on a notice board in the reception area.

Care plans were person centred and completed with the people who lived in the home, their family members and any professionals involved in their care. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected and at all times the least restrictive option was taken.

People were supported to maintain good health and the registered manager ensured nursing staff were competent in providing their healthcare. Care records showed that staff sought the input of health and social care professionals when needed.

People told us they enjoyed the food served at the home. Care records showed staff had given consideration to people’s nutritional needs and diabetic diets were catered to.

We identified that some governance procedures to assess and monitor the quality of the home were not documented. The registered manager was clearly very 'hands on' in their approach and took an active role in the daily lives of all the people using the service but admitted this sometimes meant that paperwork was not always checked effectively. The registered manager acknowledged that at times, due to not having the support of a deputy manager, completion of monitoring records was delayed.

Further information is in the detailed findings below.

The manager was registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We found that there had been an issue with missing medication prior to our inspection. The manager had reported the issue to relevant professional bodies and the Commission. We looked at the Medication Administration Records (MAR) for six people. One person’s had a five day gap on their MAR for one prescribed medicine where the nurses had not signed as given. The two medication room’s temperature records were not completed daily and there were omissions in taking the medicine fridge temperature for 23 days from 8 April 2016 to the 21 June 2016.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded. We spent time conducting a full tour of the home. There were corridors that had inclines that could be a trip hazard. The maintenance officer organised signage straight away to ensure the safety of people living at the home and staff. There was also new gravel/large stones placed at the back of the home that was unsafe for service users and staff to walk on.

People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided had been checked. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs.

Menus were flexible and alternatives were always provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat.

We observed the lunch time meal where staff were observed to support people to eat and drink with dignity.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the six files looked at there was updated information that reflected the changes of people’s health.

People told us they felt safe with staff and this was confirmed by people’s relatives who we spoke with. The registered manager had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

The staffing levels were seen to be sufficient in all areas of the home at all times to support people and meet their needs and everyone we spoke with considered there were adequate staff on duty. People were not having person centred 1-1 activities provided, to promote their wellbeing.

The home used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks and annual self-disclosure checks made with the manager. The staff files did not include a photograph of the staff. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy manager and the registered manager.

People were able to see their friends and families when they wanted. Visitors were seen to be welcomed by all staff throughout the inspection.

Records we looked at showed that the required safety checks for gas, electric and fire safety were carried out.

The six care plans we looked at gave details of people’s medical history and medication and information about the person’s life and their preferences. People were all registered with a local GP and records showed that people saw a GP, dentist, optician, and chiropodist as needed.

There were resident’s meetings seeking the feedback of the people living at Westwood Hall. There was evidence this had happened frequently over time however records looked at and in discussion with the registered manager informed that there was not a good response to residents or relatives/friends attending.

We requested information from the manager after the inspection. The information sent by the manager was the staff training matrix.

At this inspection we found a breach of Regulation 12 safe care and treatment relating to medication record keeping and safe storage of medication and staff ensuring that monitoring records for the medication rooms and medication fridge temperatures were taken to ensure medication was stored at a safe temperature. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

People were cared for in an environment that was safe. The home was seen to be clean and hygienic. Equipment at the home was well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was always available on call in case of emergencies.

Staff personnel records we looked at for training, supervision and appraisal. All staff were up to date with their training and told us they were supported by the management team. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had been made by the home, proper policies and procedures were in place. Staff were trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. One person told us. "The staff are wonderful here. I could not be happier". Staff had received training to meet the needs of the people living at the home.

Is the service caring?

We spent time in all areas of the home where we observed staff to be kind and patient to the people who lived there. Care staff and nursing staff were patient with people, asking them what they wanted and not telling them, but encouraging them in the right direction. One person told us "It's a caring place and I wouldn't want to be anywhere else, except of course in my own home". A

relative told us "The staff are very caring, my relative is so well cared for. It gives us a lot of comfort knowing this".

Is the service responsive?

People's needs were assessed before they moved into the home. People told us that all staff were very attentive and understood what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs were recorded and care and support provided in accordance with people's wishes. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they had completed a customer satisfaction survey, and if they were unhappy with anything staff would always listen. Staff told us they were clear about their roles and responsibilities. They said the management team always consulted with them before implementing changes to the management of the home and their views were taken into consideration. One member of staff said "We work as a team so all of the people living here have a good quality of life; we provide good care and would not tolerate bad practice".

We spoke with six people who used the service and three relatives. We asked people who used the service if they felt comfortable, safe and well cared for. They told us :

"The girls are very nice, they are always polite and friendly, I feel quite safe in their hands.";

"Our relative has come to the home recently and everyone has been great so far. Our family were involved in the assessment process.";

"I know what my care and treatment is and the staff are kind and caring.".

Care staff we spoke with told us they had a good relationship with other professionals who came to visit and explained the roles of the district nurses and GPs who attended regularly to those people who did not receive nursing care from the home.

We asked the manager to tell us what systems were in place to record complaints. We were told there was a complaints procedure in place and we saw that the home's statement of purpose, provided to people when they came to live at the home, contained information about the complaints procedure and encouraged people to report any concerns to the home's matron in the first instance.

'Everything is good here', 'Staff are extremely kind' and 'I have no complaints, they look after my mum very well'.

People told us they were involved in their care and treatment and were able to make choices in every day living activities such as what time to get up and level of assistance needed with personal care.

We observed that people were well cared for and treated with dignity and respect. People's needs were assessed, planned and reviewed. We found that the provider monitored the service and gained views on the service from staff and people who used the service.

Staff were appropriately trained, supervised and appraised to care for people's needs. They demonstrated an awareness and understanding of how to protect people from abuse.